Women lose S3 in their thirties, while men lose S3 in their twenties. The third heart sound is normal in children and young adults. If the patient lies on her left side, S3 will usually be louder. Use the stethoscope bell at the apex because the third heart sound has a very-low frequency.
Along with the first and second heart sounds, this extra sound creates a gallop cadence and sounds like "Kentucky." The second heart sound is unsplit in this recording so that S3 is easier to hear. The third heart sound (S3) can be heard early in diastole. Physiologically Split Second Heart Lesson In this recording, the S2 split is 60 milliseconds at peak inspiration with no splitting at peak expiration. Maximum splitting occurs at peak inspiration. This causes splitting of the second heart sound. Timing between the aortic and pulmonic components of the second heart sound varies during normal respiration. An S1 split can be associated with EKG-related abnormalities such as right bundle branch block, premature ventricular contractions, or ventricular tachycardia in adults.Ī minimally split first heart sound is a normal variation of the first heart sound. If M1 and T1 are separately distinguished, this is called an S1 split. T1 and S1 splitting can be best heard at the tricuspid location. The mitral sound (M1) typically occurs before the tricuspid sound (T1). Loud first heart sounds can also be observed in patients with thin chests.Ĭommonly, the first heart sound consists of two sounds separated by a very small interval (20-30 milliseconds). Look at the anatomy video to see the thickened mitral valve leaflets. A thickened but still movable mitral valve is generating this particular sound. The first heart sound is much louder than the second heart sound in this case. The first heart sound is usually slightly louder than the second when auscultating at the mitral valve (apex).
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